2015 年第 5 期 第 13 卷

调强放射治疗21例原发性大肝癌安全性研究

作者：

单位：

关键词：大肝癌调强放疗安全性

• 摘要：
• 【摘要】目的：探讨调强放疗（intensity-modulated radiotherapy，IMRT）治疗大肝癌（large hepatocellular carcinoma，LHCC）的安全性及可行性。方法：回顾总结2011年2月至2013年2月我科收治的21例原发性大肝癌患者，采用逆向调强放射治疗计划系统，应用8MV直线加速器,95%等剂量曲线包绕计划靶体积（PTV），剂量分割（60～70）Gy/（20～35）F，5F/w天，中位剂量60Gy。采集患者临床指标，放疗结束后2个月复查血象及肝功能。结果：21例患者接受 IMRT治疗期间,有5例（23.81%）出现3级不良反应，15例（71.43%）1~2级肝毒性反应，仅1例（4.76%）出现放射诱导的肝病（radiation induced liver disease,RILD），且8周后复查肝功能已恢复。放疗前、放疗后及放疗后2月Child-Pugh分级均无显著差异（P＞0.05）。中位AFP呈下降趋势。放疗后2月评价近期疗效，总有效率RR42.9%（0CR，9PR)，疾病控制率81%（0CR，9PR，8SD)，4例（19%）在放疗过程中或结束后立即进展；卡方检验显示门静脉癌栓、BCLC分期和Child-Pugh分级与放疗有效率相关。结论：初步观察调强放射治疗21例大肝癌的安全性良好，不良反应小，患者可耐受。
• Objective：To evaluate the safety and feasibility of intensity-modulated radiotherapy(IMRT) in 21 patients with large hepatocellular carcinoma(LHCC). Method： During Feb 2011 to Feb 2013, 21 cases with LHCC were treated with IMRT at General Hospital of Armed Polices Forces Cancer Center. Radiation therapy was delivered with a 8-MV linear accelerator by inverse treatment planning. Patients were treated with (60~70) Gy/ (20~35) f, (2~3)Gy/f, 5f/w, median dose 60Gy，prescribed to the PTV encl. 95% isodose. The CBC, platelets, liver function and abdominal MRI were obtained two months later after the end of radiotherapy. The treatment-related toxicity and tumor remission were assessed according to CTCAE 3.0 and RECIST 1.1, respectively. Result：Among 21 patients who received IMRT,5 patients(23.81%) developed more than grade 3 toxicities, which included elevation of liver enzymes in 2 cases, and hyperbilirubinemia, leukocytopenia, thrombocytopenia in 3 cases,respectively. 15 patients(71.43%) developed grade 1 to 2 liver toxicities. Only one patient(4.76%) developed radiation-induced liver disease (RILD),that of the liver function recovered to the normal level after eight weeks. The Child-Pugh classi?cation had no significant difference before and after radiotherapy as well as at 2 months after the completion of radiotherapy. Two months after treatment, the overall response rate of the 21 patients who received IMRT was 42.9%（0CR，9PR),and the local tumor control rate was 81%（0CR，9PR，8SD). In 4 patients (19%), the tumors progressed during or immediately after radiotherapy. With the chi-square test, portal vein thrombosis, BCLC staging and Child-Pugh classification were significantly related to the tumor response to radiotherapy. Conclusion：Intensity-modulated radiotherapy in the 21 patients with large hepatocellular carcinoma is safe, feasible, low toxicity and to be tolerated.